On 20-21 January 2020, a World Health Organization (WHO) delegation conducted a field visit to Wuhan to learn about the response to 2019 novel coronavirus (2019-nCOV). The mission was part of the on-going close collaboration between WHO and Chinese national, provincial, and Wuhan health authorities in responding to 2019-nCoV.
The delegation visited the Wuhan Tianhe Airport, Zhongnan hospital, Hubei provincial CDC, including the BSL3 laboratory in China’s Center for Disease Control (CDC). The delegation observed and discussed active surveillance processes, temperature screening at the airport, laboratory facilities, infection prevention and control measures at the hospital and its associated fever clinics, and the deployment of the rRT-PCR test kit to detect the virus.
Data collected through detailed epidemiological investigation and through the deployment of the new test kit nationally suggests that human-to-human transmission is taking place in Wuhan. More analysis of the epidemiological data is needed to understand the full extent of human-to-human transmission. WHO stands ready to provide support to China to conduct further detailed analysis.
The delegation discussed China’s plan to expand the 2019-nCOV case definition. This will allow China and the international community to build a clearer picture of the spectrum of severity of the novel coronavirus. The new case definition and the provision of test kits to all provinces, are expected to lead to further increases in the number of cases identified and confirmed in Hubei Province and other provinces. Increases in confirmed cases are to be expected as testing is increased.
The delegation discussed with the local authorities their on-going efforts to communicate to the general public to expect more cases of 2019-nCOV to be confirmed, and to follow public health advice regarding infection control procedures. This is especially important at a time when seasonal influenza is at its highest, and over the Chinese New Year period when many people travel across China. The delegation and their counterparts agreed close attention should be paid to hand and respiratory hygiene, food safety and avoiding mass gatherings where possible. People with fever should avoid close contact with others and seek medical help.
The facilities for fever triage and for treatment of suspected and confirmed cases were visited in Zhongnan hospital. The delegation witnessed the systems that have been put in place to provide high quality diagnostic, treatment, and isolation services. The identification of infection among 16 health care workers reinforces the importance of ensuring appropriate infection prevention and control measures are in place for patients, staff and hospital visitors at all times. All health professionals should adhere to infection control procedures even in parts of the health care system that do not usually deal with cases of infectious disease.
On 21 January 2020, at the conclusion of the visit the Chinese Government has released the primers and probes used in the rRT-PCR test kit. This follows China’s rapid identification of the virus and sharing of the genetic sequence. The primers will assist with establishing real-time RT-PCR for the detection of 2019-nCoV in other countries. Chinese experts also shared with the delegation a range of protocols that will be used in developing international guidelines, including case definitions, clinical management protocols, and infection control among others.
The delegation commended the commitment and capacity demonstrated by national, provincial, and Wuhan authorities and by hundreds of local health care workers and public health specialists working to respond to the 2019-nCOV outbreak. While challenges still remain regarding the transmission, epidemiology and our understanding of the behavior of the virus, WHO and its partners will work together with China to respond to this outbreak.